Technology
Computerized Tomography (CT) scan
Not all patients have exactly the same physical (anatomical) heart or the same clinical diagnosis. Patients also come at different times in their lives and having had Atrial Fibrillation (AF) for different amounts of time. Each person deserves to have his or her AF treated in the most efficient, effective and safe way. Therefore, the Atrial Fibrillation Ablation Center uses a variety of techniques and technologies to best modify the electrical activity for the patient.
Pulmonary veins isolation (PVI) requires three-dimensional and detailed electrical mapping of the upper heart chambers (atria) to find the sites (foci), or other types of abnormal electrical activity such as continuous or fractionated recordings. It’s an important part of the procedure. Research has demonstrated that exploring the atria for abnormal electrical signals and ablating these is required for successful outcomes in many patients. We use mapping equipment to measure the timing and the voltage of cardiac signals.
Three-dimensional imaging: Three-dimensional image integration with electrical monitoring is used for most AF ablation procedure to give real-time data on three-dimensional maps with real-time tracking of catheter location, allowing for safe and accurate diagnosis. This technology now permits us to integrate the patient's previously acquired CT or MRI of the left atria to improve and guide navigation of recording and ablation catheters. We can create color-coded three-dimensional maps to reflect timing of electrical impulse impulses, as well as the voltage of the electrical signal separating out areas of healthy heart muscle from scarred or abnormal areas
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The image on the left is taken with X-rays (fluoroscopy). Several catheters are seen in the heart. When the CT image is added to the frame (shown at the right), the location of the pulmonary veins can be clearly identified. Newest technologies allow the ablation points to be marked. |
X-ray: used during the procedure is modified to decrease exposure levels. The fluoroscopy (moving X-ray pictures) is created with digital enhancement from pictures taken at reduced frames per second and reduced exposure levels. This technique is possible because the ablation catheter movement is continuously tracked and displayed continuously on the three-dimensional electroanatomical mapping computer
BiPlane X-ray: this X-ray system can create two simultaneous images of the heart with its integrated two fluoroscopy (moving pictures of the heart) systems. This can help our doctors see how the catheters are moving through the heart in two dimensions (front to back and right to left ) without moving the X-ray equipment
Tranesophageal echocardiography (TEE) shows us the left atria very clearly using ultrasound waves. The probe placed into the esophagus (swallowing or food tube) can be positioned to see the left atrium. The TEE is used to look for clots in the heart that would become a danger to you if we performed the left atrial ablation. The TEE helps us see the transseptal instruments, position them at the correct location in the right atrium and cross to the left side
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Echocardiogram images of the heart: images are used to search for clots in the heart and to guide the transseptal insertion of the catheter from the right to the left side of the heart. |
Intracardiac echocardiography (sometimes called ICE): is a thin tube or catheter with tiny ultrasound probes that can be slipped into the vein and moved to the heart to show us the structures from the inside. The intracardiac echo is used at times to help with the transseptal procedure (much like the TEE) and to help guide positioning of the catheter during ablations
Cooled tip catheters: reduce heat loss and reduce the complications of clot formation on the catheter surface during ablation and help deliver the deeper lesions. These are important in creating continuous lesions to avoid any new rhythm problems
Cryo catheters: can be used in certain heart areas to freeze instead of heat the inside of the heart for ablation
Robotics: robotic system for catheter is available to help steer the catheters within the heart. We use the robot to steer and hold catheters during selected procedures
Thermometer: esophagus temperature is watched very closely for elevations that might mean we are at an area of the heart overlying the esophagus
Computerized medical records and databases: the computer provides us with unique ability to have information at the right time in the right place. A good example of this is the medication prescribing error reduction possible when your allergies are listed clearly or the computer automatically notes a dose that is incompatible with the medicine